Additional Content

Intimacy and Older People

By
Daniel B. Kaplan, PhD, MSW, Institute of Geriatric Psychiatry, Weill Cornell Medical College;Barbara J. Berkman, DSW, PhD, Boston College Graduate School of Social Work;Columbia University School of Social Work;Hartford Geriatric Social Work Faculty Scholars Program

The desire for intimacy does not decrease with age, and there is no age at which intimacy, including physical intimacy, is inappropriate. However, the disorders and emotional changes that often occur with aging can interfere with developing and maintaining an intimate relationship. Aging can also change the way intimacy is expressed. Studies have shown that people who remain active and who interact with other people during old age live longer, happier, healthier lives. Volunteering, taking classes, joining social groups, engaging in hobbies, and pursuing some type of spiritual or religious practice are all ways of staying connected. Even people who are confined to their home because of illness can stay connected by having others visit them or by communicating over the telephone or by e-mail.

Intimacy, particularly physical intimacy, may be lost because of the following:

Loss of a partner: Loss or absence of a partner is probably the most common age-related barrier to intimacy.

Disorders: Various disorders that become more common with aging can interfere with physical intimacy. Vascular disorders and diabetes can cause erectile dysfunction. Arthritis can limit movements and make them painful. The pain, discomfort, drugs, and worry associated with a disorder can dampen the desire for intimacy. Cognitive impairment and dementia may complicate issues of consent and comfort with intimacy. For the partner, the stress and demands of caregiving may interfere with intimacy.

Use of drugs: Older people are more likely to take drugs (such as drugs to treat high blood pressure or drugs that affect brain function) that can cause problems affecting intimacy (for example, erectile dysfunction or reduced sex drive).

Age-related changes: Levels of sex hormones decrease, causing changes that make sexual intercourse uncomfortable or difficult. For example, the lining of the vagina may thin (atrophy), and vaginal lubrication may be reduced. Sex drive may decrease.

Reluctance to discuss effects of aging: Older people who develop problems that interfere with physical intimacy or who feel embarrassed about changes in their body (for example, wrinkles or sagging flesh) may be reluctant to discuss these changes with their partner or with their doctor.

Negative stereotypes about sexuality in older people: Even healthy older people may have internalized negative stereotypes and think sexuality is inappropriate or abnormal after a certain age.

Discrepancy in expectations of partners: One partner may want certain physical expressions of intimacy, but the other does not.

Lack of privacy: Older people who live with family members or in a residential care facility have fewer opportunities for privacy, which are necessary for physical intimacy.

Shift to other forms of intimacy: Passions may mellow after years of living together. Sexual intercourse may become less frequent or stop. Many couples—most without paying much attention to it—grow comfortable with other forms of intimacy (such as touching, massaging, kissing, or Fverbal expressions of affection) that express familiarity, caring, or engagement with their partner.

Nonetheless, many older people continue to have a healthy sexual relationship. Intimacy, particularly physical intimacy, can help prevent depression and improve self-esteem and physical health. Older people who have a new sex partner should practice safe sex. More older people are acquiring sexually transmitted diseases, including AIDS. Such infections are a risk, regardless of age.

Many older people, especially those that live alone, find satisfaction and a sense of companionship in interactions with a pet. Caring for a pet can give people a sense of purpose and connectedness.

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